Autologous stem cell transplantation in light-chain amyloidosis

Treatment of patients with light-chain amyloidosis (AL amyloidosis) has changed over the last 20 years, and early mortality rates have decreased with prolongation of survival. However, many patients are not cured with conventional therapy. Therefore, all patients should be assessed at diagnosis to determine eligibility for autologous stem cell transplantation (ASCT) since high-dose melphalan and ASCT have been shown to induce long-term hematologic and clinical responses with treatment-related mortality (TRM) <5%. Earlier diagnosis, improvement of supportive care, and deeper remissions with recently available first-line therapy have substantially reduced TRM. However, procedures and experience in complex AL amyloidosis patients still vary between transplant centers because a multidisciplinary team is necessary for an individual risk-adapted approach.